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Double trouble: unit specific counselling for mode of delivery of twin pregnancy
  1. L Higgins1,
  2. S Gupta2,
  3. J Gillham2
  1. 1Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK
  2. 2St Mary's Hospital, Manchester, UK

Abstract

Introduction The incidence of multiple pregnancy is rising in the UK. The safest mode of delivery for twin pregnancies is not known.

Method Case note review of 294/324 (90.74%) twin deliveries occurring at a teaching hospital in Manchester 1 July 2007–1 July 2010 considered mode of delivery, cord acidaemia, neonatal unit admission (NNU)) and postpartum haemorrhage (PPH).

Baseline characteristics (table 1).

View this table:
Abstract PLD.45 Table 1

Baseline characteristics

Mode of delivery 55.44% of women (34.36% of those aiming for VD) deliver at least one twin by CS; risk factors include nulliparity, previous CS and gestational age <34 weeks (p<0.05). 6.43% of women achieving VD of twin one (T1) deliver twin two (T2) by CS.

Morbidity Fetal cord acidaemia occurred in 40.88% of deliveries (T2 more frequent than T1, p<0.05). T2 acidaemia was not associated with instrumental versus CS T2 delivery or cephalic versus breech T2 VD (p<0.05). Cord arterial pH was negatively associated with delivery interval (p<0.05). Admission to NNU followed 40.56% of twin deliveries; risk factors include T2 breech VDs >34 weeks and deliveries 34 to 36+6 weeks (p<0.05). 45.05% of women experienced PPH; risk factors include nulliparity, previous CS, syntocinon infusion >1 h and CS delivery of either twin (p<0.05).

Discussion The results of the Twin Birth Study are awaited. Examining unit specific figures aids patient counselling and clinician decision making to promote optimal perinatal outcomes.

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